Stabilized pharmaceutical formulations of insulin analogues and/or insulin derivatives

ABSTRACT

Stabilized pharmaceutical formulations of insulin analogues and/or insulin derivatives are disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/783,712, filed Oct. 13, 2017, which is a continuation of U.S. patentapplication Ser. No. 14/592,757, filed Jan. 8, 2015, now U.S. Pat. No.9,839,692, which claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/925,493, filed Jan. 9, 2014, and European PatentApplication No. 14305025.0, filed Jan. 9, 2014, the entire contents ofwhich are incorporated by reference herein.

INTRODUCTION

The present invention relates to a pharmaceutical formulation of atleast one insulin analogue and/or insulin derivative, a process forpreparing the pharmaceutical formulation of at least on insulin analogueand/or insulin derivative, and to a related kit. It also relates to thepharmaceutical formulation of at least one insulin analogue and/orinsulin derivative and to the related kit for use in the treatment ofdiabetes mellitus, hyperglycemia, and/or for use in lowering bloodglucose levels. The present invention also relates to the use of amedical device for administering the pharmaceutical formulation of atleast one insulin analogue and/or insulin derivative to an animal and/orhuman.

BACKGROUND OF THE INVENTION

Diabetes mellitus is a metabolic disorder in which the ability toutilize glucose is more or less completely lost.

For decades, insulin has been used in the treatment of diabetesmellitus. Several insulin formulations have been developed, e.g. insulinzinc suspension (containing Zn(II)), formulations containing protamine,etc. Further, the active pharmaceutical ingredient insulin itself hasbeen modified by developing fast acting insulin analogues (e.g. insulinaspart, insulin lispro, insulin glulisine) and long acting insulinanalogues and derivatives (e.g. insulin detemir, insulin degludec,insulin glargin). Fast acting insulin preparations are usually solutionsof insulin, while long acting insulin preparations can be suspensionscontaining insulin in crystalline and/or amorphous form precipitated bythe addition of zinc salts alone or by addition of protamine or by acombination of both.

The chemical and physical stability of insulin formulations is veryimportant. Insulin formulations are often administered by using peninjection devices or insulin pumps in which an insulin formulation isstored in cartridges until the entire cartridge is empty. Insulinformulations may also be stored in vials, requiring a stable formulationwith respect to chemical and physical stability across the shelf life ofthe formulation.

The chemical and/or physical stability of insulin, insulin analoguesand/or insulin derivatives strongly depends on the pharmaceuticalformulation, e.g. the solvent, the pH value and the excipients. Brangeet al. (Acta Pharm. Nord. 4(3), pp. 149-158, 1992) disclose severalaspects in connection with the chemical stability of insulin. WO2004/080480 discloses pharmaceutical preparations comprisingacid-stabilized insulin. GB 835,638 discloses insulin crystalsuspensions having a protracted effect. WO 98/56406 discloses stableinsulin formulations. U.S. Pat. No. 6,489,292 discloses stable aqueousinsulin preparations without phenol and cresol. U.S. Pat. No. 6,211,144discloses stable concentrated insulin preparations for pulmonarydelivery. Bhatt et al. (Pharmaceutical Research, Vol. 7, No. 6, pp.593-599, 1990) disclose chemical pathways of peptide degradation. Patelet al. (Pharmaceutical Research, Vol. 7, No. 7, pp. 703-711, 1990)disclose chemical pathways of peptide degradation. Tyler-Cross et al.(The Journal of Biological Chemistry, Vol. 266, No. 33, Issue ofNovember 25, pp. 22549-22556, 1991) disclose effects of amino acidsequence, buffers, and ionic strength on the rate and mechanism ofdeamidation of asparagine residues in small peptides. GB 840,870discloses improvements in or relating to insulin preparations. U.S. Pat.No. 6,852,694 discloses stabilized insulin formulations. Galloway et al.(Diabetes—The Journal of the American Diabetes Association, Vol. 21, No.Suppl. 2, pp. 637-648, 1972) disclose new forms of insulin. Jackson etal. disclose several aspects with regard to neutral regular insulin(Diabetes—The Journal of the American Diabetes Association, Vol. 21, No.4, pp. 235-245, 1972). Lill (Pharmazie in unserer Zeit, No. 1, pp.56-61, 2001) discloses general aspects in connection with insulinformulations. The German product specification of the medicinal productBerlinsulin® H Normal 3 mL Pen discloses a formulation containing humaninsulin, metacresol, glycerol, water and optionally hydrochloric acidand sodium hydroxide for pH adjustment. The German product specificationof the medicinal product Actrapid® discloses a formulation containinghuman insulin, zinc chloride, glycerol, metacresol, water and optionallysodium hydroxide and hydrochloric acid for pH adjustment. The FDA labelof the medicinal product Lantus® discloses a formulation containinginsulin glargine, zinc, m-cresol, glycerol 85%, polysorbate 20 and waterfor injection, wherein the pH is adjusted to approximately 4 by additionof aqueous solutions of hydrochloric acid and/or sodium hydroxide. TheFDA label of the medicinal product Humalog® discloses a formulationcontaining insulin lispro, glycerin, dibasic sodium phosphate,metacresol, zinc oxide, phenol and water for injection, wherein the pHis adjusted to 7.0-7.8 by addition of aqueous solutions of hydrochloridacid and/or sodium hydroxide. The FDA label of the medicinal productApidra® discloses a formulation containing insulin glulisine,metacresol, tromethamine, sodium chloride, polysorbate 20 and water forinjection, wherein the pH is adjusted to 7.0-7.8 by addition of aqueoussolutions of hydrochlorid acid and/or sodium hydroxide.

The solubility of insulin, insulin analogues and/or insulin derivativesin aqueous media depends on the pH value. For example, the lowestsolubility is shown close to the isoelectric point which for humaninsulin is around pH 5.3 and 5.4. Very good solubility can be observedat pH values below 4 and above 7. However, insulin suffers fromdegradation at strong acidic conditions and strong alkaline conditions.Therefore, most of the medicinal products containing insulin, insulinanalogues and/or insulin derivatives have a pH value in the range of 7.2to 7.4 and mostly buffering agents are used to achieve and maintain thepH within this range.

It has now surprisingly been found that an alternative aqueouspharmaceutical formulation comprising at least one insulin analogueand/or insulin derivative comprising sorbitol shows an excellentchemical and physical stability which qualifies this aqueouspharmaceutical formulation as a medicinal product having a defined shelflife.

SUMMARY OF THE INVENTION

One embodiment of the present invention relates to a pharmaceuticalformulation comprising

-   -   (a). at least one analogue and/or derivative of insulin; and    -   (b). Zn(II); and    -   (c). sorbitol; and    -   (d). optionally protamine.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises sorbitol which is present in a concentrationbeing sufficient to adapt the aqueous pharmaceutical formulationaccording to the present invention to an osmolality in the range from200 mOsmol/kg to 350 mOsmol/kg, from 200 mOsmol/kg to 300 mOsmol/kg,from 230 mOsmol/kg to 290 mOsmol/kg, or 260 mOsmol/kg.

In another embodiment, the pharmaceutical formulation according to thepresent invention is an aqueous pharmaceutical formulation.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises at least one analogue and/or derivative ofinsulin which has or have an isoelectric point (IEP) from 4.0 to 6.0,from 4.5 to 6.0, from 4.5 to 5.5, from 5.0 to 5.5, from 5.0 to 5.2 or5.1.

In another embodiment, the pharmaceutical formulation according to thepresent invention has a pH value in the range from 6.0 to 9.0, from 6.5to 8.5, from 7.0 to 8.0, from 7.0 to 7.8, from 7.1 to 7.6, or 7.2, 7.3,7.4 or 7.5, or 7.4.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises at least one analogue of insulin which isselected from the group consisting of insulin aspart, insulin lisproand/or insulin glulisine. In one embodiment the pharmaceuticalformulation according to the present invention comprises an analogue ofinsulin which is insulin lispro. In one embodiment the pharmaceuticalformulation according to the present invention comprises an analogue ofinsulin which is insulin aspart. In one embodiment the pharmaceuticalformulation according to the present invention comprises an analogue ofinsulin which is insulin glulisine.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises a derivative of insulin which is selectedfrom the group consisting of insulin detemir and/or insulin degludec. Inone embodiment the pharmaceutical formulation according to the presentinvention comprises a derivative of insulin which is insulin detemir. Inone embodiment the pharmaceutical formulation according to the presentinvention comprises a derivative of insulin which is insulin degludec.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises at least one analogue and/or derivative ofinsulin which is present in a concentration from 10 U/mL to 1000 U/mL,from 10 U/mL to 600 U/mL, from 10 U/mL to 300 U/mL, from 50 U/mL to 300U/mL or 100 U/mL.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises an analogue and/or derivative of insulinwhich is present in a concentration from 60 to 6000 nmol/mL, from 60nmol/mL to 3600 nmol/mL, from 60 nmol/mL to 1800 nmol/mL, from 300nmol/mL to 1800 nmol/mL or 600 nmol/mL.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises Zn(II) which is present in a concentrationfrom 0.0100 mg/mL to 0.0600 mg/mL, from 0.0150 mg/mL to 0.0500 mg/mL,from 0.0150 mg/mL to 0.0300 mg/mL, from 0.0150 mg/mL to 0.0200 mg/mL,from 0.0190 mg/mL to 0.0200 mg/mL, or 0.0196 mg/mL.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises zinc chloride (ZnCl2) or zinc oxide (ZnO) orzinc acetate (anhydrous: C₄H₆O₄Zn or dehydrate C₄H₆O₄Zn.2H₂O).

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises Zn(II) which is present in a concentrationfrom 0.0100 mg/100 U to 0.0600 mg/100 U, from 0.0150 mg/100 U to 0.0500mg/100 U, from 0.0150 mg/100 U to 0.0300 mg/100 U, from 0.0150 mg/100 Uto 0.0200 mg/100 U, from 0.0190 mg/100 U to 0.0200 mg/100 U, or 0.0196mg/100 U.

In another embodiment, the pharmaceutical formulation according to thepresent invention further comprises sodium chloride.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises sodium chloride which is present in aconcentration from 0.01 mg/mL to 15 mg/mL, from 0.1 mg/mL to 15 mg/mL,from 0.1 mg/mL to 10 mg/mL, from 1 mg/mL to 10 mg/mL, from 2.0 mg/mL to10 mg/mL, from 3.0 mg/mL to 9.0 mg/mL, from 4.0 mg/mL to 9.0 mg/mL, from5.0 mg/mL to 9.0 mg/mL, from 6.0 mg/mL to 9.0 mg/mL, from 6.8 mg/mL to8.3 mg/mL, 6.9 mg/mL, 7.0 mg/mL, 7.1 mg/mL, 7.2 mg/mL, 7.3 mg/mL, 7.4mg/mL, 7.5 mg/mL, 7.6 mg/mL, 7.7 mg/mL, 7.8 mg/mL, 7.9 mg/mL, 8.0 mg/mL,8.1 mg/mL, 8.2 mg/mL or 8.3 mg/mL, or 6.8 mg/mL.

In another embodiment, the pharmaceutical formulation according to thepresent invention further contains a buffering agent.

In another embodiment, the pharmaceutical formulation according to thepresent invention further contains a buffering agent selected from thegroup comprising 2-amino-2-hydroxymethyl-propane-1,3-diol (TRIS),phosphate, citric acid or citrate salts, acetic acid and salts thereof,glycylglycine and methionine. In one embodiment, the pharmaceuticalformulation according to the present invention further contains abuffering agent which is phosphate, or Na₂HPO₄ or Na₂HPO₄×7 H₂O.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises protamine or protamine sulfate which ispresent in a concentration from 0.10, 0.15, 0.20, 0.25, 0.30, 0.32,0.35, 0.40, 0.45 or 0.5 mg/mL.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises a stabilizing agent, which is in oneembodiment a surfactant, a polyoxyethylene derivative of sorbitanmonolaurate (e.g. polysorbate 20), a polyethoxylethylene derivate ofoleic acid (e.g. polysorbate 80), poloxamer (which is apolyoxyethylene-polyoxypropylene copolymer), or polysorbate 20 orpolysorbate 80 or mixtures thereof. In another embodiment, thestabilizing agent, in one embodiment the surfactant, the polyoxyethylenederivative of sorbitan monolaurate (e.g. polysorbate 20), thepolyethoxylethylene derivate of oleic acid (e.g. polysorbate 80),poloxamer (which is a polyoxyethylene-polyoxypropylene copolymer), orpolysorbate 20 or polysorbate 80 or mixtures thereof are/is present in aconcentration from 0.01 to 0.05 mg/mL or in a concentration of 0.010mg/mL, 0.015 mg/mL, 0.020 mg/mL, 0.025 mg/mL, 0.03 mg/mL, or 0.02 mg/mL.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises more than one analogue and/or derivative ofinsulin, wherein one analogue and/or derivative of insulin is a fastacting insulin and one analogue and/or derivative of insulin is a longacting insulin. In another embodiment, the pharmaceutical formulationaccording to the present invention comprises a fast acting insulinselected from the group comprising insulin aspart, insulin lispro and/orinsulin glulisine and a long acting insulin selected from the groupcomprising insulin glargin, insulin detemir and/or insulin degludec.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises one or more further active pharmaceuticalingredients. In one embodiment, the further active pharmaceuticalingredient is an antidiabetic agent. In another embodiment, thepharmaceutical formulation according to the present invention comprisesone or more antidiabetic agents as further active pharmaceuticalingredients selected from the group comprising: GLP-1 receptor agonists,dual GLP-1 receptor/glucagon receptor agonists, human FGF-21, FGF-21analogues, FGF-21 derivatives, insulins, human insulin, analogues ofinsulin, and derivatives of insulin. In another embodiment, thepharmaceutical formulation according to the present invention comprisesone or more further active pharmaceutical ingredients selected from thegroup comprising: insulin and insulin derivatives, GLP-1, GLP-1analogues and GLP-1 receptor agonists, polymer bound GLP-1 and GLP-1analogues, dual GLP1/GIP agonists, dual GLP1/Glucagon receptor agonists,PYY3-36 or analogues thereof, pancreatic polypeptide or analoguesthereof, glucagon receptor agonists or antagonists, GIP receptoragonists or antagonists, ghrelin antagonists or inverse agonists, Xeninand analogues thereof, DDP-IV inhibitors, SGLT2 inhibitors, dualSGLT2/SGLT1 inhibitors, biguanides thiazolidinediones, dual PPARagonists, sulfonylureas, meglitinides, alpha-glucosidase inhibitors,amylin and amylin analogues, GPR119 agonists, GPR40 agonists, GPR120agonists, GPR142 agonists, systemic or low-absorbable TGR5 agonists,Cycloset, inhibitors of 11-beta-HSD, activators of glucokinase,inhibitors of DGAT, inhibitors of protein tyrosinephosphatase 1,inhibitors of glucose-6-phosphatase, inhibitors offructose-1,6-bisphosphatase, inhibitors of glycogen phosphorylase,inhibitors of phosphoenol pyruvate carboxykinase, inhibitors of glycogensynthase kinase, inhibitors of pyruvate dehydrogenase kinase,alpha2-antagonists, CCR-2 antagonists, modulators of glucosetransporter-4, somatostatin receptor 3 agonists, HMG-CoA-reductaseinhibitors, fibrates, nicotinic acid and the derivatives thereof,nicotinic acid receptor 1 agonists, PPAR-alpha, gamma or alpha/gamma)agonists or modulators, PPAR-delta agonists, ACAT inhibitors,cholesterol absorption inhibitors, bile acid-binding substances, IBATinhibitors, MTP inhibitors, modulators of PCSK9, LDL receptorup-regulators by liver selective thyroid hormone receptor β agonists,HDL-raising compounds, lipid metabolism modulators, PLA2 inhibitors,ApoA-I enhancers, cholesterol synthesis inhibitors, lipid metabolismmodulators, omega-3 fatty acids and derivatives thereof, activesubstances for the treatment of obesity, such as

sibutramine, tesofensine, orlistat, CB-1receptor antagonists, MCH-1antagonists, MC4 receptor agonists and partial agonists, NPY5 or NPY2antagonists, NPY4 agonists, beta-3-agonists, leptin or leptin mimetics,agonists of the 5HT2c receptor, or the combinations ofbupropione/naltrexone (CONTRAVE), bupropione/zonisamide (EMPATIC),bupropione/phentermine or pramlintide/metreleptin, QNEXA(Phentermine+topiramate), lipase inhibitors, angiogenesis inhibitors, H3antagonists, AgRP inhibitors, triple monoamine uptake inhibitors(norepinephrine and acetylcholine), MetAP2 inhibitors, nasal formulationof the calcium channel blocker diltiazem, antisense oligonucleotidesagainst production of fibroblast growth factor receptor 4, prohibitintargeting peptide-1, drugs for influencing high blood pressure, chronicheart failure or atherosclerosis, such as angiotensin II receptorantagonists, ACE inhibitors, ECE inhibitors, diuretics, beta-blockers,calcium antagonists, centrally acting hypertensives, antagonists of thealpha-2-adrenergic receptor, inhibitors of neutral endopeptidase,thrombocyte aggregation inhibitors.

In another embodiment, the pharmaceutical formulation according to thepresent invention comprises more than one analogue and/or derivative ofinsulin, wherein one analogue and/or derivative of insulin is a fastacting insulin and one analogue and/or derivative of insulin is a longacting insulin. In one embodiment, the fast acting insulin is selectedfrom the group comprising insulin aspart, insulin lispro and/or insulinglulisine and wherein the long acting insulin is selected from the groupcomprising insulin detemir and/or insulin degludec.

In another embodiment, the pharmaceutical formulation according to thepresent invention consists of (a). 3.5 mg/mL insulin aspart; and (b).31.62 mg/mL sorbitol; and (c). 1.72 mg/mL metacresol; and (d). 1.50mg/mL phenol; and (e). 0.0196 mg/mL Zn(II); and (f). 0.58 mg/mL sodiumchloride; and (g). 1.88 mg/mL Na₂HPO₄×7 H₂O; and (h). sodium hydroxideand/or hydrochloric acid to adjust the pH to 7.4; and (i). water.

In another embodiment, the pharmaceutical formulation according to thepresent invention consists of (a). 3.5 mg/mL insulin aspart; and (b).31.62 mg/mL sorbitol; and (c). 1.72 mg/mL metacresol; and (d). 1.50mg/mL phenol; and (e). 0.0196 mg/mL Zn(II); and (f). 0.58 mg/mL sodiumchloride; and (g). 1.88 mg/mL Na₂HPO₄×7 H₂O; and (h). from 0.1 mg/mL to0.5 mg/mL protamine; i). sodium hydroxide and/or hydrochloric acid toadjust the pH to a pH in the range from 7.1 to 7.6 and (j). water.

The present invention also provides a pharmaceutical formulation for usein the treatment of diabetes mellitus, hyperglycemia and/or for use inlowering blood glucose levels.

The present invention also provides a process for preparing thepharmaceutical formulation according to the present invention, whereinthe components are mixed together in the form of a solution orsuspension, the desired pH is adjusted and the mixture is made up to thefinal volume with water.

The present invention also relates to a kit or combination comprisingseparate packages of the pharmaceutical formulation according to thepresent invention and of a medical device. In one embodiment, themedical device is selected from the group comprising: syringe, insulininjection system, insulin infusion system, insulin pump, insulin peninjection device.

The present invention also relates to a kit or combination comprisingseparate packages of the pharmaceutical formulation according to thepresent invention, of at least one further active pharmaceuticalingredient and optionally of a medical device In one embodiment, themedical device is selected from the group comprising: syringe, insulininjection system, insulin infusion system, insulin pump, insulin peninjection device.

The present invention also relates to a kit or combination comprisingseparate packages of the pharmaceutical formulation according to thepresent invention, of at least one further active pharmaceuticalingredient and optionally of a medical device, wherein the furtheractive pharmaceutical ingredient is an antidiabetic agent.

The present invention also relates to a kit or combination comprisingseparate packages of the pharmaceutical formulation according to thepresent invention, of at least one further active pharmaceuticalingredient and optionally of a medical device, wherein the furtheractive pharmaceutical ingredient is an antidiabetic agent selected fromthe group comprising: GLP-1 receptor agonists, dual GLP-1receptor/glucagon receptor agonists, human FGF-21, FGF-21 analogues,FGF-21 derivatives, insulins, human insulin, analogues of insulin, andderivatives of insulin. In another embodiment, the pharmaceuticalformulation according to the present invention comprises one or morefurther active pharmaceutical ingredients selected from the groupcomprising: insulin and insulin derivatives, GLP-1, GLP-1 analogues andGLP-1 receptor agonists, polymer bound GLP-1 and GLP-1 analogues, dualGLP1/GIP agonists, dual GLP1/Glucagon receptor agonists, PYY3-36 oranalogues thereof, pancreatic polypeptide or analogues thereof, glucagonreceptor agonists or antagonists, GIP receptor agonists or antagonists,ghrelin antagonists or inverse agonists, Xenin and analogues thereof,DDP-IV inhibitors, SGLT2 inhibitors, dual SGLT2/SGLT1 inhibitors,biguanides thiazolidinediones, dual PPAR agonists, sulfonylureas,meglitinides, alpha-glucosidase inhibitors, amylin and amylin analogues,GPR119 agonists, GPR40 agonists, GPR120 agonists, GPR142 agonists,systemic or low-absorbable TGR5 agonists, Cycloset, inhibitors of11-beta-HSD, activators of glucokinase, inhibitors of DGAT, inhibitorsof protein tyrosinephosphatase 1, inhibitors of glucose-6-phosphatase,inhibitors of fructose-1,6-bisphosphatase, inhibitors of glycogenphosphorylase, inhibitors of phosphoenol pyruvate carboxykinase,inhibitors of glycogen synthase kinase, inhibitors of pyruvatedehydrogenase kinase, alpha2-antagonists, CCR-2 antagonists, modulatorsof glucose transporter-4, somatostatin receptor 3 agonists,HMG-CoA-reductase inhibitors, fibrates, nicotinic acid and thederivatives thereof, nicotinic acid receptor 1 agonists, PPAR-alpha,gamma or alpha/gamma) agonists or modulators, PPAR-delta agonists, ACATinhibitors, cholesterol absorption inhibitors, bile acid-bindingsubstances, IBAT inhibitors, MTP inhibitors, modulators of PCSK9, LDLreceptor up-regulators by liver selective thyroid hormone receptor βagonists, HDL-raising compounds, lipid metabolism modulators, PLA2inhibitors, ApoA-I enhancers, cholesterol synthesis inhibitors, lipidmetabolism modulators, omega-3 fatty acids and derivatives thereof,active substances for the treatment of obesity, such as sibutramine,tesofensine, orlistat, CB-1receptor antagonists, MCH-1 antagonists, MC4receptor agonists and partial agonists, NPY5 or NPY2 antagonists, NPY4agonists, beta-3-agonists, leptin or leptin mimetics, agonists of the5HT2c receptor, or the combinations of bupropione/naltrexone (CONTRAVE),bupropione/zonisamide (EMPATIC), bupropione/phentermine orpramlintide/metreleptin, QNEXA (Phentermine+topiramate), lipaseinhibitors, angiogenesis inhibitors, H3 antagonists, AgRP inhibitors,triple monoamine uptake inhibitors (norepinephrine and acetylcholine),MetAP2 inhibitors, nasal formulation of the calcium channel blockerdiltiazem, antisense oligonucleotides against production of fibroblastgrowth factor receptor 4, prohibitin targeting peptide-1, drugs forinfluencing high blood pressure, chronic heart failure oratherosclerosis, such as angiotensin II receptor antagonists, ACEinhibitors, ECE inhibitors, diuretics, beta-blockers, calciumantagonists, centrally acting hypertensives, antagonists of thealpha-2-adrenergic receptor, inhibitors of neutral endopeptidase,thrombocyte aggregation inhibitors.

The present invention also relates to a kit or combination comprisingseparate packages of the pharmaceutical formulation according to thepresent invention, of at least one further active pharmaceuticalingredient and optionally of a medical device, wherein the kit comprisesmore than one analogue and/or derivative of insulin, wherein oneanalogue and/or derivative of insulin is a fast acting insulin and oneanalogue and/or derivative of insulin is a long acting insulin. In oneembodiment, the fast acting insulin is selected from the groupcomprising insulin aspart, insulin lispro and/or insulin glulisine andwherein the long acting insulin is selected from the group comprisinginsulin glargin, insulin detemir and/or insulin degludec.

The present invention also relates to a kit or combination comprisingseparate packages of the pharmaceutical formulation according to thepresent invention, of at least one further active pharmaceuticalingredient and optionally of a medical device for use in the treatmentof diabetes mellitus, hyperglycemia and/or for use in lowering bloodglucose levels.

In another embodiment, the present invention also relates to a kit orcombination comprising separate packages of the pharmaceuticalformulation according to the present invention, of at least one furtheractive pharmaceutical ingredient and optionally of a medical device,wherein the pharmaceutical formulation according to the presentinvention and the further active pharmaceutical ingredient, in oneembodiment an antidiabetic agent, are administered continuously,separately, sequentially and/or stepwise.

The present invention also relates to the use of a medical device foradministering the pharmaceutical formulation to an animal and/or human.In another embodiment, the medical device is selected from the groupcomprising: syringe, insulin injection system, insulin infusion system,insulin pump, insulin pen injection device.

DETAILED DESCRIPTION

As used herein, the singular forms “a”, “an”, and “the” include pluralreference unless the context clearly dictates otherwise. Thus, forexample, reference to a fill materiel containing “a carrier” includesone or more carriers, reference to “an additive” includes reference toone or more of such additives.

As used herein, the term “active pharmaceutical ingredient” (API)includes any pharmaceutically active chemical or biological compound andany pharmaceutically acceptable salt thereof and any mixture thereof,that provides some pharmacologic effect and is used for treating orpreventing a condition. Exemplary pharmaceutically acceptable saltsinclude hydrochloric, sulfuric, nitric, phosphoric, hydrobromic,maleric, malic, ascorbic, citric, tartaric, pamoic, lauric, stearic,palmitic, oleic, myristic, lauryl sulfuric, naphthalinesulfonic,linoleic, linolenic acid, and the like. As used herein, the terms“active pharmaceutical ingredient”, “drug”, “active agent”, “activeingredient”, “active substance” and “drug” are meant to be synonyms,i.e., have identical meaning.

In one embodiment the active pharmaceutical ingredient is anantidiabetic agent. Examples of antidiabetic agents are found in theRote Liste 2012, chapter 12. Examples of antidiabetic agents include butnot limited to (a) insulin, insulin analogues and insulin derivatives,(b) glucagon-like-peptide 1 (GLP-1) and its analogues and receptoragonists, (c) dual GLP-1/GIP agonists, and (d) dual GLP-1/glucagonreceptor agonists, as described in detail next.

(a). Insulin, Insulin Analogues and Insulin Derivatives

Examples of insulin, insulin analogues, and insulin derivatives includebut are not limited to insulin glargine (Lantus®), insulin glulisine(Apidra®), insulin detemir (Levemir®), insulin lispro(Humalog®/Liprolog®), insulin degludec (Tresiba®), insulin aspart(NovoLog®/NovoRapid®), basal insulin and analogues (e.g. LY2605541,LY2963016), PEGylated insulin lispro, Humulin®, Linjeta®, SuliXen®,NN1045, insulin plus Symlin®, fast-acting and short-acting insulins(e.g. Linjeta®, PH20 insulin, NN1218, HinsBet®), oral, inhalable,transdermal and sublingual insulins (e.g. Exubera®, Nasulin®, Afrezza®,insulin tregopil, TPM-02/Insulin, Capsulin®, Oral-lyn®, Cobalamin® oralinsulin, ORMD-0801, NN1953, VIAtab®). Additionally included are alsothose insulin derivatives which are bonded to albumin or another proteinby a bifunctional linker.

(b). Glucagon-Like-Peptide 1 (GLP-1), GLP-1 Analogues and GLP-1 ReceptorAgonists

Examples of GLP-1, GLP-1 analogues and GLP-1 receptor agonists includebut are not limited to lixisenatide (AVE0010/ZP10/Lyxumia®),exenatide/exendin-4 (Byetta®/Bydureon®/ITCA 650, liraglutide/Victoza®),semaglutide, taspoglutide, albiglutide, dulaglutide, rExendin-4,CJC-1134-PC, PB-1023, TTP-054, HM-11260C, CM-3, GLP-1 Eligen, ORMD-0901,NN9924, Nodexen, Viador-GLP-1, CVX-096, ZYOG-1, ZYD-1, MAR-701, ZP-2929,ZP-3022, CAM-2036, DA-15864, ARI-2651, ARI-2255, exenatide-XTEN andglucagon-XTEN, AMX-8089+VRS-859 and polymer bound GLP-1 and GLP-1analogues.

(c). Dual GLP-1/GIP Agonists

For example: MAR701, MAR-709, BHM081/BHM089/BHM098).

(d). Dual GLP-1/Glucagon Receptor Agonists

Examples of dual GLP-1/glucagon receptor agonists include but are notlimited to OAP-189 (PF-05212389, TKS-1225), TT-401/402, ZP2929,LAPS-HMOXM25, MOD-6030).

Other suitable active pharmaceutical ingredients which may be includedin the pharmaceutical formulations of the invention include but are notlimited to the following:

Further gastrointestinal peptides such as peptide YY 3-36 (PYY3-36) oranalogues thereof and pancreatic polypeptide (PP) or analogues thereof.

Glucagon receptor agonists or antagonists, GIP receptor agonists orantagonists, ghrelin antagonists or inverse agonists and xenin andanalogues thereof.

Dipeptidyl peptidase-IV (DPP-4) inhibitors, for example:alogliptin/Nesina®,linagliptin/BI-1356/Ondero®/Trajenta®/Tradjenta®/Trayenta®,saxagliptin/Onglyza®, sitagliptin/Januvia®/Xelevia®/Tesavel®,sitagliptin+metformin/Janumet®/Velmetia®, aildagliptin, anagliptin,aemigliptin, tenegliptin, melogliptin, trelagliptin, DA-1229, MK-3102,KM-223, KRP-104 and Ari-2243.

Sodium-dependent glucose transporter 2 (SGLT2) inhibitors, for example:canagliflozin, dapagliflozin, remogliflozin, sergliflozin,empagliflozin, ipragliflozin, tofogliflozin (RO-4998452),luseogliflozin, LX-4211, ertugliflozin (PF-04971729), EGT-0001442 andDSP-3235.

Dual SGLT2/SGLT1 inhibitors.

Biguanides (e.g. metformin, buformin, phenformin), thiazolidinediones(e.g. pioglitazone, rivoglitazone, rosiglitazone, troglitazone), dualPPAR agonists (e.g. aleglitazar, muraglitazar, tesaglitazar),sulfonylureas (e.g. tolbutamide, glibenclamide, glimepiride/Amaryl®,glipizide), meglitinides (e.g. nateglinide, repaglinide, mitiglinide),alpha-glucosidase inhibitors (e.g. acarbose, miglitol, voglibose),amylin and amylin analogues (e.g. pramlintide/Symlin®).

G-protein coupled receptor 119 (GPR119) agonists (e.g. GSK-1292263,PSN-821, MBX-2982, APD-597, ARRY-981).

GPR40 agonists (e.g. TAK-875, TUG-424, P-1736, JTT-851, GW9508).

GPR120 agonists and GPR142 agonists.

Systemic or low-absorbable TGR5 (GPBAR1=G-protein-coupled bile acidreceptor 1) agonists (e.g. INT-777, XL-475, SB756050).

Bromocriptine/Cycloset®, inhibitors of 11-beta-hydroxysteroiddehydrogenase (11-beta-HSD) (e.g. LY2523199, BMS770767, RG-4929,BMS816336, AZD-8329, HSD-016, BI-135585), activators of glucokinase(e.g. PF-04991532, TTP-399, GK1-399, ARRY-403 (AMG-151), TAK-329,ZYGK1), inhibitors of diacylglycerol O-acyltransferase (DGAT) (e.g.pradigastat (LCQ-908), LCQ-908), inhibitors of proteintyrosinephosphatase 1 (e.g. trodusquemine), inhibitors ofglucose-6-phosphatase, inhibitors of fructose-1,6-bisphosphatase,inhibitors of glycogen phosphorylase, inhibitors of phosphoenol pyruvatecarboxykinase, inhibitors of glycogen synthase kinase, inhibitors ofpyruvate dehydrogenase kinase, alpha2 adrenergic receptor antagonists,C-C chemokine receptor type 2 (CCR-2) antagonists, modulators of glucosetransporter-4 and somatostatin receptor 3 agonists (e.g. MK-4256).

One or more lipid lowering agents are also suitable as activepharmaceutical ingredients, such as for example:3-hydroxy-3-methylglutaryl-coenzym-A-reductase (HMG-CoA-reductase)inhibitors (e.g. simvastatin, atorvastatin, rosuvastatin), fibrates(e.g. bezafibrate, fenofibrate), nicotinic acid and derivatives thereof(e.g. niacin, including slow release formulations of niacin), nicotinicacid receptor 1 agonists (e.g. GSK-256073), peroxisomeproliferator-activated receptors (PPAR-)(alpha, gamma or alpha/gamma)agonists or modulators (e.g. aleglitazar), PPAR-delta agonists,acetyl-CoA-acetyltransferase (ACAT) inhibitors (e.g. avasimibe),cholesterol absorption inhibitors (e.g. ezetimibe), bile acid-bindingsubstances (e.g. cholestyramine, colesevelam), ileal bile acid transportinhibitors (IBAT) (e.g. GSK-2330672), microsomal triglyceride transferprotein (MTP) inhibitors (e.g. lomitapide (AEGR-733), SLx-4090,granotapide), modulators of proprotein convertase subtilisin/kexin type9 (PCSK9) (e.g. REGN727/SAR236553, AMG-145, LGT-209, PF-04950615,MPSK3169A, LY3015014, ALD-306, ALN-PCS, BMS-962476, SPC5001,ISIS-394814, 1B20, LGT-210, 1D05, BMS-PCSK9Rx-2, SX-PCK9, RG7652), LDLreceptor up-regulators, for example liver selective thyroid hormonereceptor beta agonists (e.g. eprotirome (KB-2115), MB07811, sobetirome(QRX-431), VIA-3196, ZYT1), HDL-raising compounds such as: CETPinhibitors (e.g. torcetrapib, anacetrapib (MK0859), dalcetrapib,evacetrapib, JTT-302, DRL-17822, TA-8995, R-1658, LY-2484595) or ABC1regulators, lipid metabolism modulators (e.g. BMS-823778, TAP-301,DRL-21994, DRL-21995), phospholipase A2 (PLA2) inhibitors (e.g.darapladib/Tyrisa®, varespladib, rilapladib), ApoA-I enhancers (e.g.RVX-208, CER-001, MDCO-216, CSL-112, VRX-HDL, VRX-1243, VIRxSYS),cholesterol synthesis inhibitors (e.g. ETC-1002) and lipid metabolismmodulators (e.g. BMS-823778, TAP-301, DRL-21994, DRL-21995) and omega-3fatty acids and derivatives thereof (e.g. icosapent ethyl (AMR101),Epanova®, AKR-063, NKPL-66).

Other suitable active pharmaceutical ingredients which may be includedin the pharmaceutical formulations include one or more active substancesfor the treatment of obesity, including but not limited to:

Sibutramine, tesofensine, orlistat, cannabinoid receptor 1 (CB1)antagonists (e.g. TM-38837), melanin-concentrating hormone (MCH-1)antagonists (e.g. BMS-830216, ALB-127158(a)), MC4 receptor agonists andpartial agonists (e.g. AZD-2820, RM-493), neuropeptide Y5 (NPY5) or NPY2antagonists (e.g. velneperit, S-234462), NPY4 agonists (e.g. PP-1420),beta-3-adrenergic receptor agonists, leptin or leptin mimetics, agonistsof the 5-hydroxytryptamine 2c (5HT2c) receptor (e.g. lorcaserin), or thecombinations of bupropione/naltrexone (Contrave®), bupropione/zonisamide(Empatic®), bupropione/phentermine or pramlintide/metreleptin,phentermine/topiramate (Qsymia®), lipase inhibitors (e.g.cetilistat/Cametor®), angiogenesis inhibitors (e.g. ALS-L1023),histamine H3 antagonists (e.g. HPP-404), AgRP (agouti related protein)inhibitors (e.g. TTP-435), triple monoamine uptake inhibitors (dopamine,norepinephrine and serotonin reuptake) (e.g. tesofensine), methionineaminopeptidase 2 (MetAP2) inhibitors (e.g. beloranib), nasalformulations of the calcium channel blocker diltiazem (e.g. CP-404) andantisense oligonucleotides against production of fibroblast growthfactor receptor 4 (FGFR4) (e.g. ISIS-FGFR4Rx) or prohibitin targetingpeptide-1 (e.g. Adipotide®).

Further suitable active pharmaceutical ingredients which may be includedin the pharmaceutical formulations include but are not limited to:

Angiotensin II receptor antagonists (e.g. telmisartan, candesartan,valsartan, losartan, eprosartan, irbesartan, olmesartan, tasosartan,azilsartan), angiotensin converting enzyme (ACE) inhibitors, endothelinconverting enzyme (ECE) inhibitors, diuretics, beta-blockers, calciumantagonists, centrally acting hypertensives, antagonists of thealpha-2-adrenergic receptor, inhibitors of neutral endopeptidase,thrombocyte aggregation inhibitors and others or combinations thereofare suitable.

As used herein, the terms “analogue of insulin” and “insulin analogue”refers to a polypeptide which has a molecular structure which formallycan be derived from the structure of a naturally occurring insulin, forexample that of human insulin, by deleting and/or exchanging at leastone amino acid residue occurring in the naturally occurring insulinand/or adding at least one amino acid residue. The added and/orexchanged amino acid residue can either be codable amino acid residuesor other naturally occurring residues or purely synthetic amino acidresidues. Examples of analogues of insulin include, but are not limitedto, the following: (i). ‘Insulin aspart’ is created through recombinantDNA technology so that the amino acid B28 in human insulin (i.e. theamino acid no. 28 in the B chain of human insulin), which is proline, isreplaced by aspartic acid; (ii). ‘Insulin lispro’ is created throughrecombinant DNA technology so that the penultimate lysine and prolineresidues on the C-terminal end of the B-chain of human insulin arereversed (human insulin: Pro^(B28)Lys^(B29); insulin lispro:Lys^(B28)Pro^(B29)); (iii). ‘Insulin glulisine’ differs from humaninsulin in that the amino acid asparagine at position B3 is replaced bylysine and the lysine in position B29 is replaced by glutamic acid;(iv). “Insulin glargine” differs from human insulin in that theasparagine at position A21 is replaced by glycine and the B chain isextended at the carboxy terminal by two arginines.

As used herein, the term “aqueous” refers to a solution in which thesolvent is water and/or to a suspension in which the external phase iswater and/or to an emulsion in which the dispersed or continuous phaseis water.

As used herein, the term “buffering agent” refers to a weak acid or baseused to maintain the acidity (pH) of a solution, a suspension and/or anemulsion near a chosen value after the addition of another acid or base.The function of a buffering agent is to prevent a rapid change in the pHvalue when acids or bases are added to the solution. In an aqueoussolution, suspension and/or emulsion, a buffering agent is present in amixture of a weak acid and its conjugate base or a in a mixture of aweak base and its conjugated acid. Examples of buffering agents include,but are not limited to, the following: sodium bicarbonate; acetic acidor acetate salts (e.g. sodium acetate, zinc acetate); boric acid orboric salts; N-cyclohexyl-2-aminoethanesulfonic acid (CHES) or saltsthereof;3-[[1,3-dihydroxy-2-(hydroxymethyl)propan-2-yl]amino]propane-1-sulfonicacid (TAPS) or salts thereof; 2-(N-morpholino)ethanesulfonic acid (MES)and salts thereof; piperazine-N,N′-bis(2-ethanesulfonic acid (PIPES) andsalts thereof; N-(2-acetamido)-2-aminoethane-sulfonic acid (ACES) andsalts thereof; cholamine chloride; BES;2-[[1,3-dihydroxy-2-(hydroxymethyl)-propan-2-yl]amino]ethanesulfonicacid (TES) and salts thereof;2-[4-(2-hydroxyethyl)piperazin-1-yl]ethanesulfonic acid (HEPES) andsalts thereof; acetamidoglycine;N-(2-hydroxy-1,1-bis(hydroxyl-methyl)ethyl)glycine (tricine);glycinamide; 2-(bis(2-hydroxyethyl)amino)acetic acid (bicine) and saltsthereof; propionate salts;3-[[1,3-dihydroxy-2-(hydroxymethyl)propan-2-yl]-amino]-2-hydroxy-propane-1-sulfonicacid (TAPSO) and salts thereof; 3-morpholinopropane-1-sulfonic acid(MOPS) and salts thereof; saline-sodium citrate (SSC) buffer;2-amino-2-hydroxymethyl-propane-1,3-diol (synonyms: TRIS, trisamine,THAM, tromethamine, trometamol, tromethane); citric acid or citratesalts (e.g. sodium citrate); trisodium phosphate, disodium hydrogenphosphate, sodium dihydrogen phosphate, tripotassium phosphate,dipotassium phosphate, monopotassium phosphate and/or any otherbuffering agent containing phosphate.

Amino acids (having free basic or acidic functional groups, e.g.methionin, arginine) or peptides (having free basic or acidic functionalgroups) may also be used as buffering agent. As used herein, the term“buffering agent” also comprises amino acids, peptides and proteins. Asinsulin analogues and/or insulin derivatives and/or protamine arepeptides or derivatives of peptides (i.e. both contain amino acidshaving free basic or acidic functional groups), they may also have acertain buffering capacity, i.e. are also to be considered as bufferingagent.

As used herein, the term “fast acting insulin” or “short acting insulin”refers to insulin analogues and/or insulin derivatives, wherein theinsulin-mediated effect begins within 5 to 15 minutes and continues tobe active for 3 to 4 hours. Examples of fast acting insulins include,but are not limited to, the following: (i). insulin aspart; (ii).insulin lispro and (iii). insulin glulisine.

As used throughout the description and the claims of this specification,the word “comprise” and variations of the word, such as “comprising” and“comprises” is not intended to exclude other additives, components,integers or steps.

As used herein, the terms “derivative of insulin” and “insulinderivative” refers to a polypeptide which has a molecular structurewhich formally can be derived from the structure of a naturallyoccurring insulin, for example that of human insulin, in which one ormore organic substituents (e.g. a fatty acid) is bound to one or more ofthe amino acids. Optionally, one or more amino acids occurring in thenaturally occurring insulin may have been deleted and/or replaced byother amino acids, including non-codeable amino acids, or amino acids,including non-codeable, have been added to the naturally occurringinsulin. Examples of derivatives of insulin include, but are not limitedto, the following: (i). ‘Insulin detemir’ which differs from humaninsulin in that the C-terminal threonine in position B30 is removed anda fatty acid residue (myristic acid) is attached to the epsilon-aminofunction of the lysine in position B29. (ii). ‘Insulin degludec’ whichdiffers from human insulin in that the last amino acid is deleted fromthe B-chain and by the addition of a glutamyl link from Lys^(B29) to ahexadecandioic acid.

As used herein, the term “FGF-21” means “fibroblast growth factor 21”.FGF-21 compounds may be human FGF-21, an analogue of FGF-21 (referred to“FGF-21 analogue”) or a derivative of FGF-21 (referred to “FGF-21derivative”).

As used herein, the term “formulation” refers to a product comprisingspecified ingredients in predetermined amounts or proportions, as wellas any product that results, directly or indirectly, from combiningspecified ingredients in specified amounts. In relation topharmaceutical formulations, this term encompasses a product comprisingone or more active ingredients, and an optional carrier comprising inertingredients, as well as any product that results, directly orindirectly, from combination, complexation or aggregation of any two ormore of the ingredients, or from dissociation of one or more of theingredients, or from other types of reactions or interactions of one ormore of the ingredients. In general, pharmaceutical formulations areprepared by uniformly bringing the active pharmaceutical ingredient(i.e. the analogue and/or derivative of insulin) into association with aliquid carrier or a finely divided solid carrier or both, and then, ifnecessary, shaping the product into the desired formulation. Thepharmaceutical formulation includes enough of the active pharmaceuticalingredient to produce the desired effect upon the progress or conditionof diseases. As used herein, the term “formulation” may refer to asolution as well as to a suspension or to an emulsion. As used herein,the terms “formulation” and “composition” are meant to be synonyms,i.e., have identical meaning. The pharmaceutical compositions are madefollowing conventional techniques of pharmaceutical technology involvingmixing, filling and dissolving the ingredients, as appropriate, to givethe desired oral, parenteral, rectal, transdermal, or topical products.

As used herein, the term “GLP-1 receptor agonist” refers to compoundswhich have an agonistic activity at the glucagon-like peptide-1receptor. Examples of GLP-1 receptor agonists include, but are notlimited to, the following: exenatide/exendin-4, liraglutide,lixisenatide, dulaglutide, albiglutide, semaglutide, taspoglutide,rExendin-4, CJC-1134-PC, PB-1023, TTP-054, HM-11260C, CM-3, GLP-1Eligen, ORMD-0901, NN9924, Nodexen, Viador-GLP-1, CVX-096, ZYOG-1,ZYD-1, MAR-701, ZP-2929, ZP-3022, CAM-2036, DA-15864, ARI-2651,ARI-2255, exenatide-XTEN and glucagon-XTEN, AMX-8089+VRS-859 and polymerbound GLP-1 and GLP-1 analogues.

As used herein, the term “dual GLP-1 receptor/glucagon receptor agonist”refers to compounds which have agonistic activity at both the GLP-1receptor and the glucacon receptor. Examples of dual GLP-1receptor/glucagon receptor agonist include, but are not limited to, thefollowing: oxyntomodulin, MAR701, MAR-709, and BHM081/BHM089/BHM098.

As used herein, the term “human insulin” refers to the human hormonewhose structure and properties are well-known. Human insulin has twopolypeptide chains (chains A and B) that are connected by disulphidebridges between cysteine residues, namely the A-chain and the B-chain.The A-chain is a 21 amino acid peptide and the B-chain is a 30 aminoacid peptide, the two chains being connected by three disulphidebridges: one between the cysteins in position 6 and 11 of the A-chain;the second between the cysteine in position 7 of the A-chain and thecysteine in position 7 of the B-chain; and the third between thecysteine in position 20 of the A-chain and the cysteine in position 19of the B-chain.

As used herein, the term “including” is used to mean “including but notlimited to”. “Including” and “including but not limited to” are usedinterchangeably.

As used herein, the term “isoelectric point” (pI, IEP) refers to the pHvalue at which a particular molecule carries no net electrical charge.The isoelectric point can be determined by using isoelectric focusing,which is a technique for separating different molecules by differencesin their isoelectric point and which is well known in the art. It canalso be calculated (see e.g. Levene and Simms, ‘Calculation ofisoelectric point’ J. Biol. Chem., 1923, pp. 801-813).

As used herein, the term “kit” refers to a product (e.g. medicament,kit-of-parts) comprising one package or one or more separate packagesof:

(i). A pharmaceutical formulation containing an active pharmaceuticalingredient and at least one further active pharmaceutical ingredient andoptionally a medical device. The at least one further activepharmaceutical ingredient may be present in said pharmaceuticalformulation, i.e. the kit may comprise one or more packages, whereineach package comprises one pharmaceutical formulation which comprisestwo or more active pharmaceutical ingredients. The further activepharmaceutical ingredient may also be present in a furtherpharmaceutical formulation, i.e. the kit may comprise separate packagesof two or more pharmaceutical formulations, wherein each pharmaceuticalformulation contain one active pharmaceutical ingredient.

Or

(ii). A pharmaceutical formulation containing an active pharmaceuticalingredient and medical device.

A kit may comprise one package only or may comprise one or more separatepackages

For example, the kit may be a product (e.g. medicament) containing twoor more vials each containing a defined pharmaceutical formulation,wherein each pharmaceutical formulation contains at least one activepharmaceutical ingredient. For example, the kit may comprise (i.) a vialcontaining a defined pharmaceutical formulation and (ii). further atablet, capsule, powder or any other oral dosage form which contains atleast one further active pharmaceutical ingredient. The kit may furthercomprise a package leaflet with instructions for how to administer thepharmaceutical formulation and the at least one further activepharmaceutical ingredient.

As used herein, the term “medical device” means any instrument,apparatus, implant, in vitro reagent or similar or related article thatis used to diagnose, prevent, or treat a disease of other condition, anddoes not achieve its purpose through pharmacological action within or onthe body. As used herein, a medical device may be a syringe, an insulininjection system, an insulin infusion system, an insulin pump or aninsulin pen injection device. As used herein, a medical device may bemechanically or electromechanically driven.

As used herein, unless specifically indicated otherwise, the conjunction“or” is used in the inclusive sense of “and/or” and not the exclusivesense of “either/or”.

As used herein, the term “pH” and “pH value” refer to the decimallogarithm of the reciprocal of the hydrogen ion activity in a solution.

As used herein, the term “pharmaceutical” refers to the intended use inthe medical diagnosis, cure, treatment and/or prevention of diseases.

As used herein, the term “pharmaceutically acceptable” refers tophysiologically well tolerated by a mammal or a human.

As used herein, the term “protamine” refers to a mixture of stronglybasic peptides. It was originally isolated from the sperm of salmon andother species of fish but is now produced primarily recombinant throughbiotechnology. It contains more than two-thirds of L-arginine. Asprotamine contains amino acids having free basic side chains, it has acertain buffering capacity and is therefore considered to be a bufferingagent. Protamine may be used as protamine sulfate and protaminehydrochloride.

Concentrations, amounts, solubilities, particle size, wavelength, pHvalues, weight mass, molecular weight, percent and other numerical datemay be expressed or presented herein in a range format. It is to beunderstood that such a range format is used merely for convenience andbrevity and thus should be interpreted flexibly to include not only thenumerical values explicitly recited as the limits of the range, but alsoto include all the individual numerical values or sub-ranges encompassedwithin that range as if each numerical value and sub-range is explicitlyrecited.

As used herein, the term “long acting insulin” refers to insulinanalogues and/or insulin derivatives, wherein the insulin-mediatedeffect begins within 0.5 to 2 hours and continues to be active for aboutor more than 24 hours. Examples of fast acting insulins include, but arenot limited to, the following: (i). insulin glargin; (ii). insulinedetemir and (iii). insulin degludec.

As used herein, the term “stability” refers to the chemical and/orphysical stability of active pharmaceutical ingredients, in particularof insulin analogues and/or derivatives. The purpose of stabilitytesting is to provide evidence on how the quality of an activepharmaceutical ingredient or dosage form varies with time under theinfluence of a variety of environmental factors such as temperature,humidity, and light, and to establish a shelf life for the activepharmaceutical ingredient or dosage form and recommended storageconditions. Stability studies can include testing of those attributes ofthe active pharmaceutical ingredient that are susceptible to changeduring storage and are likely to influence quality, safety, and/orefficacy. The testing can cover, as appropriate, the physical, chemical,biological, and microbiological attributes, preservative content (e.g.,antioxidant, antimicrobial preservative), and functionality tests (e.g.for a dose delivery system). Analytical procedures can be fullyvalidated and stability indicating. In general, significant changes foran active pharmaceutical ingredient and/or dosage form with regard tostability are defined as:

-   -   a 5% change in assay from its initial value; or failure to meet        the acceptance criteria for potency when using biological or        immunological procedures;    -   any degradation products exceeding its acceptance criterion;    -   failure to meet the acceptance criteria for appearance, physical        attributes, and functionality test (e.g., color, phase,        separation, resuspendibility, caking, hardness, dose delivery        per actuation); however, some changes in physical attributes        (e.g. softening of suppositories, melting of creams) may be        expected under accelerated conditions;    -   and, as appropriate for the dosage form:    -   failure to meet the acceptance criterion for pH; or    -   failure to meet the acceptance criteria for dissolution for 12        dosage units.

The significant changes may also be evaluated against establishedacceptance criteria prior to starting the evaluation of the stability.

Acceptance criteria can be derived from the monographs (e.g. monographsfor the European Pharmacopeia, of the United States Pharmacopeia, of theBritish Pharmacopeia, or others), and from the analytical batches of theactive pharmaceutical ingredient and medicinal product used in thepreclinical and clinical studies. Acceptable limites should be proposedand justified, taking into account the levels observed in material usedin preclinical and clinical studies. Product characteristics may bevisual appearance, purity, color and clarity for solutions/suspensions,visible particulates in solutions, and pH. As a non-limiting example,suitable acceptance criteria for insulin aspart formulations are shownbelow:

Acceptance criteria Test item for clinical trials Appearance of solution(visual) Clarity and degree of opalescence Monitoring Degree ofcoloration Monitoring Assay insulin aspart units (HPLC) 90.0 insulinaspart units/mL to 110.0 insulin aspart units/mL Related impurities(HPLC) B28isoAsp insulin aspart equal or below to 2.5% Total of A21Aspinsulin aspart, equal or below to 5.0% B3Asp insulin aspart and B3isoAspinsulin aspart Any other unspecified, equal or below to 2.0%unidentified impurity Total of other impurities equal or below to 3.5%High molecular weight proteins equal or below to 1.5% (HPSEC) pH 7.0 to7.8 Particulate matter (visible particles) Practically free of visibleparticles Particulate matter (subvisible Number of particles percontainer: particles) equal or larger to 10 μm: equal or below to 6000equal or larger to 25 μm: equal or below to 600 Assay m-cresol 1.55 to1.89 [mg/mL] Assay phenol 1.35 to 1.65 [mg/mL] Zinc (Zn(II) ) (AAS)below 40 μg per 100 units insulin aspart

The acceptance criteria shown above are based on monographed acceptancelimits (e.g. British Pharmacopoeia, Volume III, 2012 or PharmacopoeialForum, Volume 36(6), November-December 2010) and/or are derived fromextensive experience in the development of insulin formulations.

As used herein, the term “treatment” refers to any treatment of amammalian, for example human condition or disease, and includes: (1)inhibiting the disease or condition, i.e., arresting its development,(2) relieving the disease or condition, i.e., causing the condition toregress, or (3) stopping the symptoms of the disease.

As used herein, the unit of measurement “U” and/or “international units”refers to the blood glucose lowering activity of insulin and is defined(according to the World Health Organization, WHO) as follows: 1 Ucorresponds to the amount of highly purified insulin (as defined by theWHO) which is sufficient to lower the blood glucose level of a rabbit(having a body weight of 2-2.5 kg) to 50 mg/100 mL within 1 hour and to40 mg/100 mL within 2 hours. For human insulin, 1 U corresponds toapproximately 35 μg (Lill, Pharmazie in unserer Zeit, No. 1, pp. 56-61,2001). For insulin aspart, 100 U correspond to 3.5 mg (productinformation NovoRapid®). For insulin lispro, 100 U correspond to 3.5 mg(product information Humalog®). For insulin glulisine, 100 U correspondto 3.49 mg (product information Apidra® cartridges). For insulindetermir, 100 U correspond to 14.2 mg (product information Levemir®).For insulin glargin, 100 U correspond to 3.64 mg (product informationLantus®).

Further embodiments of the present invention include the following:

In one aspect, the invention provides a pharmaceutical formulationcomprising (a). at least one analogue and/or derivative of insulin; and(b). Zn(II); and (c). sorbitol; and (d). optionally protamine.

In one aspect, the pharmaceutical formulation of the invention is anaqueous pharmaceutical formulation.

In one aspect, the pharmaceutical formulation of the invention has a pHvalue in the range from 6.0 to 9.0.

In one aspect, the pharmaceutical formulation of the invention has a pHvalue in the range from 7.0 to 7.8.

In one aspect, the pharmaceutical formulation of the invention comprisesan analogue of insulin which is selected from the group consisting ofinsulin aspart, insulin lispro and insulin glulisine.

In one aspect, the pharmaceutical formulation of the invention comprisesa derivative of insulin which is insulin detemir and/or insulindegludec.

In one aspect, the pharmaceutical formulation of the invention comprisesan analogue and/or derivative of insulin which is present in aconcentration from 10 U/mL to 1000 U/mL.

In one aspect, the pharmaceutical formulation of the invention comprisesZn(II) which is present in a concentration from 0.0100 to 0.0600 mg/100U of the analogue and/or derivative of insulin.

In one aspect, the pharmaceutical formulation of the invention furthercontains sodium chloride.

In one aspect, the pharmaceutical formulation of the invention comprisessodium chloride which is present in a concentration from 0.01 to 6.0mg/mL.

In one aspect, the pharmaceutical formulation of the invention comprisesprotamine which is present in a concentration from 0.1 to 0.5 mg/mL.

In one aspect, the pharmaceutical formulation of the invention comprisesone or more further active pharmaceutical ingredients.

In one aspect, the pharmaceutical formulation of the invention comprisesa further active pharmaceutical ingredient which is an antidiabeticagent.

In one aspect, the pharmaceutical formulation of the invention comprisesa further active pharmaceutical ingredient which is an antidiabeticagent selected from the group consisting of: (a). a GLP-1 receptoragonist; (b). a dual GLP-1 receptor/glucagon receptor agonist; (c).human FGF-21; (d). a FGF-21 analogue; (e). a FGF-21 derivative; (f).insulin; (g). human insulin; (h). an analogue of insulin; and (i). aderivative of insulin.

In one aspect, the pharmaceutical formulation of the invention comprisesmore than one analogue and/or derivative of insulin, wherein oneanalogue and/or derivative of insulin is a fast acting insulin and oneanalogue and/or derivative of insulin is a long acting insulin.

In one aspect, the pharmaceutical formulation of the invention comprisesmore than one analogue and/or derivative of insulin, wherein oneanalogue and/or derivative of insulin is a fast acting insulin and oneanalogue and/or derivative of insulin is a long acting insulin, whereinthe fast acting insulin is one or more insulin selected from the groupconsisting of insulin aspart, insulin lispro and insulin glulisine andwherein the long acting insulin is one or more insulin selected from thegroup consisting of insulin detemir and insulin degludec.

In one aspect, the pharmaceutical formulation of the invention consistsof: (a). 3.5 mg/mL insulin aspart; (b). 31.62 mg/mL sorbitol; (c). 1.72mg/mL metacresol; (d). 1.50 mg/mL phenol; (e). 0.0196 mg/mL Zn(II); (f).0.58 mg/mL sodium chloride; (g). 1.88 mg/mL Na₂HPO₄×7 H₂O; (h). sodiumhydroxide and/or hydrochloric acid to adjust the pH to 7.4; and (i).water.

In one aspect, the pharmaceutical formulation of the invention consistsof: (a). 3.5 mg/mL insulin aspart; (b). 31.62 mg/mL sorbitol; (c). 1.72mg/mL metacresol; (d). 1.50 mg/mL phenol; (e). 0.0196 mg/mL Zn(II); (f).0.58 mg/mL sodium chloride; (g). 1.88 mg/mL Na₂HPO₄×7 H₂O; a (h). from0.1 mg/mL to 0.5 mg/mL protamine; (i). sodium hydroxide and/orhydrochloric acid to adjust the pH to a pH in the range from 7.1 to 7.6;(j). and water.

In one aspect, the invention provides a process for preparing thepharmaceutical formulation of the invention, wherein the components aremixed together in the form of an solution or suspension, the pH isadjusted to reach the desired pH and water is added to reach the finalvolume.

In one aspect, the invention provides a kit comprising one or moreseparate packages of (a). the pharmaceutical formulation of theinvention; and (b). a medical device.

In one aspect, the invention provides a kit comprising one or moreseparate packages of (a). the pharmaceutical formulation of theinvention; and (b). at least one further active pharmaceuticalingredient; (c). and optionally a medical device.

In one aspect, the kit of the invention comprises a further activepharmaceutical ingredient which is an antidiabetic agent.

In one aspect, the kit of the invention comprises a further activepharmaceutical ingredient which is an antidiabetic agent selected fromthe group consisting of: (a). a GLP-1 receptor agonist; (b). a dualGLP-1 receptor/glucagon receptor agonist; (c). ahuman FGF-21; (d). aFGF-21 analogue; (e). a FGF-21 derivative; (f). insulin; (g). humaninsulin; (h). an analogue of insulin; and (i). a derivative of insulin.

In one aspect, the kit of the invention comprises more than one analogueand/or derivative of insulin, wherein one analogue and/or derivative ofinsulin is a fast acting insulin and one analogue and/or derivative ofinsulin is a long acting insulin.

In one aspect, the kit of the invention comprises more than one analogueand/or derivative of insulin, wherein one analogue and/or derivative ofinsulin is a fast acting insulin and one analogue and/or derivative ofinsulin is a long acting insulin, wherein the fast acting insulin isselected from the group consisting of insulin aspart, insulin lispro andinsulin glulisine and wherein the long acting insulin is selected fromthe group consisting of insulin glargin, insulin detemir and/or insulindegludec.

In one aspect, the invention provides a pharmaceutical formulation orkit for use in the treatment of diabetes mellitus.

In one aspect, the invention provides a pharmaceutical formulation orkit for use in the treatment of hyperglycemia.

In one aspect, the invention provides a pharmaceutical formulation orkit for use in lowering blood glucose level.

In one aspect, the invention provides a method of treating diabetesmellitus in a subject in need thereof comprising administering thepharmaceutical formulation of the invention.

In one aspect, the invention provides a method of treating hyperglycemiain a subject in need thereof comprising administering the pharmaceuticalformulation of the invention.

In one aspect, the invention provides a method of lowering blood glucoselevels in a subject in need thereof comprising administering thepharmaceutical formulation of the invention.

In one aspect, the invention provides a medical device for administeringthe pharmaceutical formulation of the invention to an animal and/orhuman.

The present invention is illustrated by the following Examples. However,it should be understood that the present invention is not limited to thespecific details of these examples.

EXAMPLES Example 1 Manufacturing Process (a) Zinc Chloride Solution

Zinc Chloride Solution was prepared by dissolving 2.00 g zinc chloridein water for injection and by filling up with water for injection tofinal volume of 1000 mL.

(b) Solution A

The final composition of Solution A is given in Table 1:

TABLE 1 Composition of Solution A Composition Composition Excipient per200 mL per 2000 mL 1. di-Natriumhydrogen- 1.88 g 18.8 g phosphat * 7 H₂O2. Sodium chloride 0.58 g  5.8 g 3. Sorbitol 31.62 g  316.2 g  4. Phenol 1.5 g 15.0 g 5. m-Cresol 1.72 g 17.2 g 6. Sodium hydroxide solution adpH 8.65 ad pH 8.65 7. Hydrochloric acid ad pH 8.65 ad pH 8.65 8. Waterfor Injection ad 200 mL = ad 2000 mL = 201.5 g  2015 g 

Solution A was prepared as described in the following:

-   -   1. It was started with approximately 1000 g water for injection.    -   2. 18.8 g di-Natriumhydrogen-phosphat*7H₂O, 5.8 g sodium        chloride, 316.2 g Sorbitol, 15.0 g phenol and 17.2 g m-cresol        were dissolved while stirring constantly.    -   3. Solution was filled up to approximately 1800 g with water for        injection.    -   4. Solution was stirred for approximately 15 min using a        magnetic stirrer.    -   5. pH was checked (pH should be 8.65). If pH value is not 8.65,        the pH was adjusted to said range using hydrochloric acid 0.03 N        or sodium hydroxide solution 1 N.    -   6. Solution was filled up to 2015 g (2000 mL) with water for        injection.

(c) Final Solution

The final composition of Final Solution is given in Table 2:

TABLE 2 Composition of Final Solution Composition CompositionComposition Excipient per mL per 1000 mL per 2000 mL  1. Insulin aspart3.5 mg 3.5 g 7.0 g  2. Zn(II) 19.6 μg 0.0196 g 0.0392 g  3.di-Natriumhydrogen- 1.88 mg 1.88 g 3.76 g phosphat * 7 H₂O  4. Sodiumchloride 0.58 mg 0.58 g 1.16 g  5. Sorbitol 31.62 mg 31.62 g 63.24 g  6.Phenol 1.50 mg 1.50 g 3.0 g  7. m-Cresol 1.72 mg 1.72 g 3.44 g  8.Sodium hydroxide ad pH 7.4 ad pH 7.4 ad pH 7.4  9. Hydrochloric acid adpH 7.4 ad pH 7.4 ad pH 7.4 10. Water for Injection ad 1 mL = ad 1000 mL= ad 2000 mL = 1.005 g 1005 g 2010 g

Final Solution was prepared as described in the following:

-   -   1. It was started with 300 mL water for injection.    -   2. 7.0 g insulin aspart was added to the 300 mL water for        injection while stirring constantly (a suspension of insulin        aspart in water for injection is formed).    -   3. pH value was checked.    -   4. pH value was changed to approximately 3.1 to 3.2 by adding        hydrochloric acid 0.03 N or sodium hydroxide solution 0.02 N to        dissolve the insulin aspart.    -   5. Solution was stirred for approximately 15 min using a        magnetic stirrer.    -   6. 41 mL Zinc Chloride Solution was added to the solution while        stirring constantly.    -   7. Solution was filled up to 600 g with water for injection.    -   8. 400 mL Solution A was added slowly and carefully while        stirring constantly.    -   9. pH was adjusted to 7.4 (range 7.2 to 7.6) using hydrochloric        acid 0.03 N or sodium hydroxide solution 0.02 N.    -   10. Solution was filled up to 2010 g with water for injection        (corresponds to 100% of the Final Solution).

Quality control: Final solution was a clear and uncoloured solution,showed a pH value of 7.4 (plus/minus 0.2; at 20-25° C.).

The Final Solution was applied to sterile filtration using ‘SartoporeMinisart high flow’ filter (filter material: polyethersulfone; poresize: 0.2 μm; supplier: Sartorius).

The Final Solution after sterile filtration was a clear and uncolouredsolution and showed an osmolarity of 260 mOsmol/kg (plus/minus 30).

The Final Solution after sterile filtration was filled into appropriatevials (volume: 5 and 10 mL; 13 mm; clear glas; glas type 1).

The vials—containing the Final Solution after sterile filtration—werestored between +2° C. and +8° C. and protected from light.

Example 2 Control of the Formulation

(a) Analytical procedures

Tests are carried out using compendial analytical test methods, whereapplicable. The quality control concept has been established taking intoaccount the cGMP requirements as well as the current status of the ICHprocess.

The non-compendial and chromatographic analytical procedures used tocontrol the formulation are summarized in the following:

Description

Visually examined a number of containers for conformance to theacceptance criteria.

Identification (HPLC)

The identity of the active ingredient is ensured by comparing theretention time of the drug formulation sample with the retention time ofthe reference standard using a reversed phase HPLC method. The method isalso used for the determination of assay of the active ingredient, forthe determination of the related compounds and impurities, and forquantifying the preservatives m-cresol and phenol.

Assay (HPLC)

The test is carried out by reverse phase liquid chromatography (HPLC).The method is also used for the identification, the determination ofassay of the active ingredient, for the determination of the relatedcompounds and impurities, and for quantifying the preservatives m-cresoland phenol. Column: Lichrosorb RP18, particle size 5 μm, pore size 100 Å(250 mm×4.0 mm), thermostated at +35° C. Autosampler: Thermostated at≤+8° C. Mobile phase A: Sodium sulfate solved in water, 14 g/mL,adjusted with phosphoric acid and sodium hydroxide to a pH of 3.4.Mobile phase B: Water/acetonitrile (50:50 v/v). Gradient is shown inTable 3.

TABLE 3 HPLC gradient Time [min] Mobile phase A [%] Mobile phase B [%] 0 to 42 57.7 42.3 42 to 47 linear to 20 80 47 to 52 20 80 52 to 53linear to 57.7 42.3 53 to 60 equilibration 57.7 42.5

Flow rate: 1.0 mL/min. Injection volume: 10 μL. Detection: 214 nm (forthe active ingredient) and 260 nm (for m-cresol and phenol). Typical runtime: 60 min.

Assay of the active ingredient, m-cresol and phenol are calculated byexternal standardization.

Impurities are calculated using the peak area percent method.

Test solution: The formulation is used without any dilution or furthertreatment.

Related Compounds and Impurities (HPLC)

The same chromatographic conditions as for “Assay (HPLC)” are used forthe determination of related compounds and impurities. Related compoundsand Impurities are calculated using the peak area percent method.

High Molecular Weight Proteins (HMWPs)

The high molecular weight proteins are determined using high pressuresize exclusion chromatography (HPSEC). Column: Waters Insulin HMWP,particle size 5-10 μm, pore size 12-12.5 nm (300 mm×7.8 mm),thermostated at room temperature. Autosampler: thermostated at ≤+8° C.Mobile phase: 650 mL of arginine solution (1 g/L) is mixed with 200 mLof acetonitrile and 150 mL of glacial acetic acid. Isocratic elutionFlow rate: 1.0 mL/min. Injection volume: 100 μL.

Detection: 276 nm. Typical run time: 35 min.

HMWPs are calculated using the peak area percent method. Test solution:The formulation is used without any dilution or further treatment.

Antimicrobial Preservative Assay

The same chromatographic conditions as for “Assay (HPLC)” are used forthe determination of assay of m-Cresol and of phenol m-cresol and phenolare calculated by external standardization.

(b) Validation of Analytical Procedures

The HPLC analytical procedure for the formulation for the determinationof identification, assay, and related compounds and impurities wasvalidated to demonstrate specificity, linearity, limit of detection andlimit of quantification, accuracy, precision and range.

(c) Justification of the Acceptance Criteria

Tests and acceptance criteria, as previously presented, were selectedbased on ICH Q6B and on published monographs, analytical resultsobtained, precision of procedures used, Pharmacopoeial and/or regulatoryguidelines, and are in agreement with the standard limits at this stageof development.

Example 3 Stability of the Formulation (a) Stability of the Formulation

Stability studies for the formulation were initiated according to thestability protocol summary described in the following table. Thecomposition and manufacturing method of the stability batches arerepresentative of the material. The stability profile was assessed forstorage under long term, accelerated, and stress testing conditionsaccording to ICH guidelines. Samples were packed and stored in glassvials with flanged cap with inserted disc and flip-off lid. Thestability data obtained using this packaging material are representativefor the preliminary shelf life and storage direction for both packagingconfigurations (10 mL glass vials and 3 mL cartridges). 6 monthsstability data are available from ongoing stability studies of theformulation.

TABLE 4 Storage Conditions Storage Condition Sampling IntervalsContainer Long Term +5° C. ± 3° C. 1, 2, 3, and 6 months 10 mL vialsAccelerated +25° C. ± 2° C./60% ± 5% RH 1, 2, 3, and 6 months 10 mLvials Stress +40° C. ± 5° C./75% ± 5% RH 1 month 10 mL vialsPhotostability Sun test according to ICH 1 day 10 mL vials guidelines*Indoor light** 14 days 10 mL vials *Overall illumination of not lessthan 1.2 million lux hours and an integrated near ultraviolet energy ofnot less than 200 watt hours/m2. A dark control sample is stored underthe same conditions to eliminate any effects due to local temperaturechanges **Variolux, Heraeus, standard fluorescent tubes, GE-Lightening,Type F40/33, irradiance approximately 8 W/m2, 2000 Lux. A dark controlsample is stored under the same conditions to evaluate any effects dueto local temperature changes

The following tests were performed during stability testing: appearance,assay, related impurities, high molecular weight proteins, pH,particulate matter (visible and subvisible particles), assay ofantimicrobial preservatives (m-cresol and phenol), content of Zn(II).The investigations on physical and chemical properties after 6 months ofstorage at the long term storage condition of +5° C. confirm thestability of the formulation when stored at the recommended storagecondition. Only very slight changes of the related impurities could beobserved.

When stored at accelerated conditions (6 months at +25° C./60% RH) therelated impurities and high molecular weight proteins increased and werefound out of specification after 3 months. When stored at acceleratedconditions (1 month at +40° C./75% RH) one of the related impuritiesincreased above the acceptance criterion. The content of the activeingredient decreased, but was found within the specified acceptancecriteria after 1 months storage at +40° C. The content of the microbialpreservatives, m-cresol and phenol, remained basically unchanged underaccelerated conditions.

When stored exposed to light (sun test according to ICH guidelines for 1day and indoor light for 14 days) the related impurities (total of otherimpurities) and high molecular weight proteins increased above theacceptance criteria. The content of the active ingredient, m-cresol andphenol, remained basically unchanged after photostability testing.

Due to the present results of the stability studies of the formulation,the chemical and physical stability of the formulation can be confirmed.

Tables 5-8 show the long term stability results, wherein batch no.“_0026” refers to a formulation according to the present invention.

The stability of the formulation as presently claimed shows an excellentchemical and physical stability which qualifies said aqueouspharmaceutical formulation as medicinal product having a defined shelflife.

TABLE 5:1 Long term stability +5° C. batch _0026 Storage condition: +5°C. ± 3° C. Acceptance criteria for Time Test item clinical trialsInitial results 1 month 3 months 6 months Appearance of solution(visual) Clarity Monitoring <I (water clear) <I (water clear) <I (waterclear) <I (water clear) Color Monitoring B9 B9 B9 B9 Assay in insulin90.0 insulin aspart 106.9 insulin 105.1 insulin 104.3 insulin 103.7insulin aspart units (HPLC) units/mL to 110.0 aspart units/mL aspartunits/mL aspart units/mL aspart units/mL insulin aspart (3.74 mg/mL)(3.68 mg/mL) (3.65 mg/mL) (3.63 mg/mL) units/mL Related Compounds(HPLC)B28isoAsp insulin aspart ≤2.5% 0.21% 0.20% 0.31% 0.42% Total of A21Aspinsulin ≤5.0% 1.32% 1.23% 1.46% 1.63% aspart, B3Asp insulin aspart andB3isoAsp insulin aspart Any other unspecified, ≤2.0% 0.41% 0.47% 0.71%0.95% unidentified impurity Total of other impurities ≤3.5% 0.61% 0.75%0.78% 1.14% High molecular weight ≤1.5% 0.21% 0.22% 0.36% 0.38% proteins(HPSEC) pH Between 7.0 to 7.8 7.46 7.46 Not tested 7.47 Particulatematter Practically free from Complies Complies Complies Complies(visible particles) visible particles Particulate matter Number ofparticles 1 Not tested Not tested 1 (subvisible particles) per container0 0 ≥10 μm: ≤6000 ≥25 μm: ≤600  Assay m-cresol 1.55 mg/mL to 1.89 1.81mg/mL 1.81 mg/mL 1.75 mg/mL 1.80 mg/mL mg/mL (90.0% to (105.2%) (105.2%)(101.7%) (104.7%) 110.0% of label claim) Assay phenol 1.35 mg/mL to 1.651.53 mg/mL 1.53 mg/mL 1.53 mg/mL 1.56 mg/mL mg/mL (90.0% to (102.0%)(102.0%) (102.0%) (104.0%) 110.0% of label claim) Zinc (Zn(II) ) (AAS)μg per 100 units 19.0 μg per 100 Not tested Not tested Not testedinsulin aspart units insulin aspart (20.3 μg/mL)

TABLE 6 Accelerated stability +25° C./60% RH batch _0026 Storagecondition: +25° C. ± 2° C./60% ± 5% RH Acceptance criteria for Time Testitem clinical trials Initial results 1 month 3 months 6 monthsAppearance of solution (visual) Clarity Monitoring <I (water clear) <I(water clear) <I (water clear) <I (water clear) Color Monitoring B9 B9B9 B8 Assay in insulin aspart 90.0 insulin aspart 106.9 insulin 103.1insulin 102.0 insulin 98.3 insulin units (HPLC) units/mL to 110.0 aspartunits/mL aspart units/mL aspart units/mL aspart units/mL insulin aspartunits/mL (3.74 mg/mL) (3.61 mg/mL) (3.57 mg/mL) (3.44 mg/mL) RelatedCompounds(HPLC) B28isoAsp insulin aspart ≤2.5% 0.21% 0.81% 2.18% 3.99%Total of A21Asp insulin ≤5.0% 1.32% 1.84% 3.11% 4.52% aspart, B3Aspinsulin aspart and B3isoAsp insulin aspart Any other unspecified, ≤2.0%0.41% 0.36% 2.33% 4.92% unidentified impurity Total of other impurities≤3.5% 0.61% 1.46% 2.47% 5.31% High molecular weight ≤1.5% 0.21% 0.43%1.03% 1.87% proteins (HPSEC) pH Between 7.0 to 7.8 7.46 7.46 Not tested7.47 Particulate matter Practically free from Complies Complies Nottested Complies (visible particles) visible particles Particulate matterNumber of particles 1 Not tested Not tested 3 (subvisible particles) percontainer 0 0 ≥10 μm: ≤6000 ≥25 μm: ≤600  Assay m-cresol 1.55 mg/mL to1.89 1.81 mg/mL 1.80 mg/mL 1.74 mg/mL 1.79 mg/mL mg/mL (90.0% to(105.2%) (104.7%) (101.2%) (104.1%) 110.0% of label claim) Assay phenol1.35 mg/mL to 1.53 mg/mL 1.53 mg/mL 1.53 mg/mL 1.56 mg/mL 1.65 mg/mL(102.0%) (102.0%) (102.0%) (104.0%) (90.0% to 110.0% of label claim)Zinc (Zn(II) ) (AAS) <40 μg per 19.0 μg per Not tested Not tested 20.1μg per 100 units 100 units 100 units insulin aspart insulin aspartinsulin aspart (20.3 μg/mL) (19.8 μg/mL)

TABLE 7 Accelerated stability +40° C./75% RH batch _0026 Storagecondition: +40° C. ± 2° C./75% ± 5% RH Acceptance criteria for Time Testitem clinical trials Initial results 1 month Appearance of solution(visual) Clarity Monitoring <I (water clear) <I (water clear) ColorMonitoring B9 B8 Assay in insulin aspart units 90.0 insulin aspart 106.9insulin 92.0 insulin (HPLC) units/mL to 110.0 aspart units/mL aspartunits/mL insulin aspart units/mL (3.74 mg/mL) (3.22 mg/mL) RelatedCompounds(HPLC) B28isoAsp insulin aspart ≤2.5% 0.21% 4.17% Total ofA21Asp insulin ≤5.0% 1.32% 4.33% aspart, B3Asp insulin aspart andB3isoAsp insulin aspart Any other unspecified, ≤2.0% 0.41% 1.20%unidentified impurity Total of other impurities ≤3.5% 0.61% 4.81% Highmolecular weight ≤1.5% 0.21% 1.76% proteins (HPSEC) pH Between 7.0 to7.8 7.46 7.45 Particulate matter Practically free from complies Does notcomply to (visible particles) visible particles acceptance criteriaParticulate matter Number of particles 1 1 (subvisible particles) percontainer 0 0 ≥10 μm: 6000 ≥25 μm: 600  Assay m-cresol 1.55 mg/mL to1.89 1.81 mg/mL 1.80 mg/mL mg/mL (90.0% to (105.2%) (104.7%) 110.0% oflabel claim) Assay phenol 1.35 mg/mL to 1.65 1.53 mg/mL 1.53 mg/mL mg/mL(90.0% to (102.0%) (102.0%) 110.0% of label claim) Zinc (Zn (II) ) (AAS)<40 μg per 100 19.0 μg per 100 21.7 μg per 100 units insulin unitsinsulin aspart units insulin aspart aspart (20.3 μg/mL) (20.0 μg/mL)

TABLE 8 Photostability Suntest batch _0026 Suntest per ICH guideline andindoor light Time Storage condition: Acceptance criteria Sun test (ICH)Indoor light Test item for clinical trials 0 Dark control 1 day Darkcontrol 14 days Appearance of solution (visual) Clarity Monitoring <I(water clear) <I (water clear) <I (water clear) <I (water clear) <I(water clear) Color Monitoring B9 B9 B5 B9 B6 Assay in insulin aspartunits 90.0 insulin aspart 106.9 insulin 105.7 insulin 93.7 insulin 105.1insulin 98.3 insulin (HPLC) units/mL to 110.0 aspart aspart aspartaspart aspart insulin aspart units/mL units/mL units/mL units/mLunits/mL units/mL (3.74 mg/mL) (3.70 mg/mL) (3.28 mg/mL) (3.68 mg/mL)(3.44 mg/mL) Related Compounds(HPLC) B28isoAsp insulin aspart ≤2.5%0.21% 0.22% 0.23% 0.48% 0.50% Total of A21Asp insulin aspart, ≤5.0%1.32% 1.00% 1.32% 1.42% 1.94% B3Asp insulin aspart and B3isoAsp insulinaspart Any other unspecified, ≤2.0% 0.41% 0.36% 1.78% 0.42% 0.57%unidentified impurity Total of other impurities ≤3.5% 0.61% 0.80% 8.57%0.97% 4.96% High molecular weight proteins ≤1.5% 0.21% 0.24% 4.33% 0.32%3.47% (HPSEC) pH Between 7.0 to 7.8 7.46 7.45 7.47 7.46 7.44 Particulatematter (visible Practically free from complies Complies CompliesComplies Complies particles) visible particles Particulate matter(subvisible Number of particles 1 0 5 3 3 particles) per container ≥10μm: ≤6000 0 0 0 0 0  25 μm:  ≤600 Assay m-cresol 1.55 mg/mL to 1.89 1.81mg/mL 1.83 mg/mL 1.79 mg/mL 1.85 mg/mL 1.84 mg/mL mg/mL (90.0% to(105.2%) (106.4%) (104.1%) (107.6%) (107.0%) 110.0% of label claim)Assay phenol 1.35 mg/mL to 1.65 1.53 mg/mL 1.56 mg/mL 1.53 mg/mL 1.58mg/mL 1.51 mg/mL mg/mL (90.0% to (102.0%) (104.0%) (102.0%) (105.3%)(104.7%) 110.0% of label claim) Zinc (Zn (II)) (AAS) <40 μg per 100units 19.0 μg per 100 19.3 μg per 100 22.0 μg per 100 19.3 μg per 10020.9 μg per 100 insulin aspart units insulin units insulin units insulinunits insulin units insulin aspart aspart aspart aspart aspart (20.3μg/mL) (20.4 μg/mL) (20.6 μg/mL) (20.3 μg/mL) (20.5 μg/mL)

1. A pharmaceutical formulation comprising (a) at least one analogueand/or derivative of insulin; (b) Zn(II); (c) sorbitol; and (d)optionally protamine.
 2. The pharmaceutical formulation according toclaim 1, wherein the pharmaceutical formulation is an aqueouspharmaceutical formulation.
 3. The pharmaceutical formulation accordingto claim 1, wherein the pharmaceutical formulation has a pH value in therange from 6.0 to 9.0.
 4. The pharmaceutical formulation according toclaim 3, wherein the pharmaceutical formulation has a pH value in therange from 7.0 to 7.8.
 5. The pharmaceutical formulation according toclaim 1, wherein the analogue of insulin is selected from the groupconsisting of insulin aspart, insulin lispro and insulin glulisine. 6.The pharmaceutical formulation according to claim 1, wherein thederivative of insulin is insulin detemir and/or insulin degludec.
 7. Thepharmaceutical formulation according to claim 1, wherein the analogueand/or derivative of insulin is present in a concentration from 10 U/mLto 1000 U/mL.
 8. The pharmaceutical formulation according to claim 1,wherein Zn(II) is present in a concentration from 0.0100 to 0.0600mg/100 U of the analogue and/or derivative of insulin.
 9. Thepharmaceutical formulation according to claim 1, wherein thepharmaceutical formulation further contains sodium chloride.
 10. Thepharmaceutical formulation according to claim 9, wherein sodium chlorideis present in a concentration from 0.01 to 6.0 mg/mL.
 11. Thepharmaceutical formulation according to claim 1, wherein protamine ispresent in a concentration from 0.1 to 0.5 mg/mL.
 12. The pharmaceuticalformulation according to claim 1, wherein the pharmaceutical formulationcomprises one or more further active pharmaceutical ingredients. 13.(canceled)
 14. (canceled)
 15. The pharmaceutical formulation accordingto claim 1, wherein the pharmaceutical formulation comprises more thanone analogue and/or derivative of insulin, wherein one analogue and/orderivative of insulin is a fast acting insulin and one analogue and/orderivative of insulin is a long acting insulin.
 16. (canceled) 17.(canceled)
 18. (canceled)
 19. A process for preparing the pharmaceuticalformulation according to claim 1, wherein the components are mixedtogether in the form of a solution or suspension, the pH is adjusted toreach a desired pH and water is added to reach a final volume.
 20. A kitcomprising one or more separate packages of (a) the pharmaceuticalformulation according to claim 1; and (b) a medical device.
 21. A kitcomprising one or more separate packages of (a) the pharmaceuticalformulation according to claim 1; and (b) at least one further activepharmaceutical ingredient; and (c) optionally a medical device. 22-28.(canceled)
 29. A method of treating diabetes mellitus in a subject inneed thereof comprising administering to the subject a therapeuticallyeffective amount of the pharmaceutical formulation of claim
 1. 30. Amethod of treating hyperglycemia in a subject in need thereof comprisingadministering to the subject a therapeutically effective amount of thepharmaceutical formulation of claim
 1. 31. A method of lowering bloodglucose levels in a subject in need thereof comprising administering tothe subject a therapeutically effective amount of the pharmaceuticalformulation of claim
 1. 32. A medical device comprising thepharmaceutical formulation of claim 1, for administering thepharmaceutical formulation to an animal and/or human.